CQC report explained · a nursing home
What the CQC found at Decoy Farm
Rated Requires improvement: inspectors found the home was not performing as well as it should and told it what to change.
- Safe?
- Requires improvement
- Oral medicines were given safely, but records for creams had gaps and some guidance for medicines given when needed or hidden in food was unclear. Staffing sometimes fell below the required level, although a contingency plan was being developed.
- Effective?
- Requires improvement
- Training had improved, but newer staff needed more training for consistent support. Records and monitoring of food intake, healthy options and people's weights were not always robust.
- Caring?
- Good
- Inspectors saw kind interactions and found that people were treated with dignity and respect. People and relatives were involved in care decisions, and staff encouraged independence.
- Responsive?
- Good
- Care plans included people's needs and preferences, and people were taking part in more chosen activities. The home used different communication methods and complaints were recorded with actions taken.
- Well-led?
- Requires improvement
- The new manager had improved communication and promoted person-centred care, but audits had not always identified shortfalls in staffing, nutrition and medicines records.
What inspectors found, April 2023
Decoy Farm was rated Requires Improvement; care was kind and responsive, but staffing, medicines records, nutrition monitoring and management checks were not always reliable.
Inspectors visited without notice on 23 August and 2 September 2022. They reviewed care plans and medicines records, observed care, spoke with people, staff, relatives and professionals, and checked infection control.
The home was rated Good for Caring and Responsive. People were treated with kindness, involved in decisions, supported to be independent and helped to take part in activities they chose, including activities in the community.
The home was rated Requires Improvement for Safe, Effective and Well-led. Inspectors found gaps in records for creams, occasional staffing levels below what people needed, inconsistent support from newer staff, weaknesses in nutrition monitoring and audits that had not always found problems.
The overall rating stayed at Requires Improvement. The home had improved since the previous inspection and was no longer in breach of regulations, but CQC said it would continue to monitor progress.
Kind and respectful care
Relatives consistently described kind and respectful treatment. Inspectors also observed positive interactions and good relationships between the core staff team and people.
“Relatives were consistent in their feedback that staff treated people with kindness and respected their privacy.” from the report
More choice and activities
People were going out more often and taking part in activities they chose. They were also involved in planning events and expressing their views.
“People were going out more frequently and taking part in activities which they chose.” from the report
Improved management and communication
The new manager had introduced daily meetings, improved communication and created ways for people and staff to give feedback. Staff and relatives reported positive changes.
“The new manager encourages feedback and I find email works best. I receive a reply very quickly” from the report
Partnership working
The home worked with health and social care professionals and referred people to specialist services when needed. Professionals said the manager was open to advice.
“The service had referred people to specialist services and professionals to ensure their care and treatment was effective.” from the report
Staffing could fall below safe levels
seriousThere were occasions when staffing fell below the level required for people's support. Inspectors said a stronger contingency plan was needed, including consideration of staff skills.
“There had been some occasions when staffing levels dropped below what was required.” from the report
Medicines records were incomplete
seriousRecords for creams and other topical medicines had gaps. Some written instructions for medicines given when needed or hidden in food were also unclear.
“We noted gaps in records for the application of people's topical medicines such as creams and emollients” from the report
Nutrition and weight checks needed improvement
needs fixingThe home did not always record food choices, refusals or weights clearly. Inspectors could not be fully assured that healthy options were consistently offered and served.
“Records relating to people's dietary intake and weight management needed to be more robustly monitored.” from the report
Newer staff needed more training
needs fixingSome newer staff needed further training so that support was consistent and effective, particularly when managing behaviour and reducing potential risks.
“Further training was needed for newer staff, so they understood the most effective approach to use” from the report
Audits had missed shortfalls
needs fixingManagement checks were in place but had not always identified problems in care records, staffing, nutrition and medicines documentation. More focused auditing was needed.
“Standardised audits were in place and checks of the service were completed at different managerial levels, but these had not always identified shortfalls.” from the report
- 01What contingency arrangements are now in place when staff are off sick, and how do you make sure people still receive their required 1:1 or 2:1 support?
- 02How do you check that creams and other topical medicines are given and recorded every time?
- 03How are people's food intake, healthy choices, refusals and weights monitored and reviewed?
- 04What extra training do newer staff receive to make sure they use consistent approaches, including behaviour support?
- 05How have your audits changed so they identify staffing, nutrition and medicines problems promptly?
This was an unannounced follow-up inspection after the previous inspection, covering all five rating areas and infection prevention and control, with particular attention to action required from the earlier inspection. This explanation was written from the published report of 27 April 2023 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
What inspectors found, September 2021
Rated Requires Improvement overall; inspectors found unsafe staffing, medicines and infection-control arrangements, and rated leadership Inadequate.
This was an unannounced focused inspection on 29 June and 12 July 2021. Inspectors looked only at Safe and Well-led, after concerns about safe care and support. They spoke with people, staff and relatives, observed care, and checked care, medicines, staffing and management records.
The home was not always safe. Agency staff did not always have the skills needed, planned staffing levels were not consistently met, and one-to-one support was not always provided as recorded. Inspectors also found medicines errors, incomplete safety checks and gaps in cleaning records linked to infection risks.
Leadership was rated Inadequate. Management had been unstable, there had been no registered manager since November 2019, and checks did not reliably identify or deal with problems. Some improvements were under way, including more community activities and work to improve staff practice, but the home remained in breach of regulations.
Community involvement
People were being supported to return to community activities, including volunteering, using public transport and developing everyday skills.
“People were getting back to more community-based activities.” from the report
Choice and independence
Inspectors found that people were mainly supported to make choices and have control over their lives, using the least restrictive approach.
“People were mainly supported to have maximum choice and control of their lives” from the report
Health reviews
Regular meetings with different professionals were helping to monitor people's physical and mental health needs.
“Regular multi-disciplinary meetings were held, with a psychiatrist present.” from the report
Staff skills and cover
seriousAgency staff did not always have the specialist skills needed. Staffing levels, breaks and one-to-one cover were not consistently delivered as people's records required.
“Agency staff were working with people, including on a one to one basis, without the necessary skills, training and competence to recognise and understand people's needs and risks.” from the report
Medicines safety
seriousThe electronic medicines system was not reliably identifying errors. One person received the wrong dose for at least seven days, and other medicines checks and instructions were incomplete.
“We identified where a person had been given the incorrect dosage of a medicine for at least seven days.” from the report
Risk and infection records
seriousSome risks were not fully assessed or managed. Inspectors found gaps in cleaning records and incomplete fire and night-time safety arrangements.
“There were gaps in cleaning records, including of touch points and communal facilities.” from the report
Weak oversight
seriousManagement checks did not consistently identify problems with medicines and staffing. The lack of a registered manager and changes in the management team affected stability.
“Audits were not always identifying shortfalls and risks to people.” from the report
- 01What conditions are currently on the provider's registration, and how are you meeting them?
- 02How do you make sure agency staff understand each person's needs, risks and one-to-one support requirements?
- 03What checks now prevent medicines errors, including errors caused by the electronic medicines system?
- 04Who is providing day-to-day leadership while there is no registered manager?
- 05How do you check that cleaning, fire safety and night-time checks are completed and recorded?
This was a focused inspection of Safe and Well-led only; ratings for Effective, Caring and Responsive were carried forward from the previous comprehensive inspection. This explanation was written from the published report of 15 September 2021 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
Every inspection of Decoy Farm
5 rated inspections over 6 years: the service has slipped, from Good to Requires improvement.
- April 2023Requires improvementcurrent ratingstayed Requires improvementSafe: Requires improvementEffective: Requires improvementCaring: GoodResponsive: GoodWell-led: Requires improvement
- September 2021Requires improvementstayed Requires improvementSafe: Requires improvementWell-led: Inadequate
- February 2021Requires improvementstayed Requires improvementSafe: Requires improvementWell-led: Requires improvement
- September 2019Requires improvementdown from GoodSafe: Requires improvementEffective: Requires improvementCaring: Requires improvementResponsive: Requires improvementWell-led: Requires improvement
- January 2017GoodSafe: GoodEffective: GoodCaring: GoodResponsive: OutstandingWell-led: Good
- September 2014
Report published without a new overall rating.
- October 2013
Report published without a new overall rating.
- December 2012
Report published without a new overall rating.
- June 2011
Report published without a new overall rating.
- February 2011
Report published without a new overall rating.
- December 2010
Registered with the Care Quality Commission on 30 December 2010.
Ratings and report dates from the Care Quality Commission, Open Government Licence v3.0. A home can also be visited without a new rating being published, so the timeline shows published inspections.
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